Two Indian states promise to enforce act that punishes violent attacks against doctors

Doctors’ associations across India have scored a victory in their campaign for better implementation of the Medical Protection Act, with the state governments of Uttar Pradesh and Tamil Nadu agreeing to educate their police forces about the provisions of the act. The government of Haryana has promised similar action in the coming weeks, leading the state branch of the Indian Medical Association (IMA) to cancel a strike scheduled for 20 May.

The Medical Protection Act makes attacks on doctors and clinical property a non-bailable offence, punishable by imprisonment of up to three years and a penalty of Rs50 000 (£500; €690; $785). It is currently in force in 17 states. But, although it is widely implemented in some states such as Andhra Pradesh, the first state to pass the act, others such as Uttar Pradesh and Bihar haven’t seen state-wide adoption. As a result, there is no legal deterrent to the escalating incidents of violence against doctors in these states.

Last month Rohit Gupta, a gastroenterologist at Anand Hospital in Allahabad, was attacked by the relatives of an 80 year old patient who had died from multiple organ failure hours after being admitted to the hospital. Enraged by the death, which they attributed to medical negligence, the patient’s relatives stormed the hospital in the early morning and beat Gupta with rods. The incident was condemned by doctors across Uttar Pradesh, who organised a state-wide protest on 8 May. All healthcare services, except emergency departments of hospitals, were shut for the day.

Sharad Kumar Agarwal, president of the Uttar Pradesh branch of the IMA, said that, although the Medical Protection Act was passed in September 2013, police were not aware of it and harboured an insensitive attitude towards violent attacks against doctors. “They have created the act to please doctors, but nobody has bothered to check if it is being used at the ground level,” Agarwal told The BMJ.

He said that police officers were so uninformed that they asked the victims of violence which act was applicable to the crime. “Doctors are a very soft target for society and the administration because they don’t want to sit in dharnas [protests],” said Agarwal. “But it has come to a point where we have to fight for our survival.” He said that after the protest the chief secretary of health for Uttar Pradesh told the IMA that police in every district would be educated about the act and asked to be more proactive and sensitive when dealing with violence against doctors.

A state-wide shutdown of healthcare in Tamil Nadu on 2 May also yielded a response from the state government, M Balasubramanian, past president of the Tamil Nadu branch of the IMA, told The BMJ. “Even though there have been more than 40 attacks on hospitals, no FIR [First Information Report] was filed by the police. No one was convicted,” he said. After the strike the secretary to the department of health in Tamil Nadu assured the IMA that police would be educated in the provisions of the act.

Meanwhile, the Haryana branch of the IMA has cancelled a strike by medical establishments scheduled for 20 May because government authorities have promised to get back to them with measures to implement the act. Anil Kumar Goel, the president of the Haryana branch, told The BMJ that if the measures weren’t put in place soon the body would go ahead with a state-wide shutdown of medical services.

The Haryana branch is also demanding changes in the Clinical Establishments (Registration and Regulation) Act 2010 and the implementation of the Pre-conception and Pre-natal Diagnostics Techniques Act, both of which are unnecessarily harsh on doctors in their current form, Goel said. Doctors in the eastern state of Bihar, who have also been demanding better implementation, have received no response from their state governments yet.

The IMA is pushing for the Medical Protection Act to be implemented across all 29 states in India. KK Aggarwal, secretary general of the association, told The BMJ, “If an act is passed across five states, it can be mooted as a central act.” The IMA has drawn up a draft act to be passed at the national level and will be seeking the opinions of its members before submitting it to the government towards the end of May.

However, Sharad Kumar Agarwal said that no act would function as a deterrent unless the misconceptions that people harbour about medical practice were cleared. “There is a perception that if there is any death, it is due to medical negligence. Fundamentally, no doctor wants bad results, but they can’t guarantee positive results,” he said.